Associations between Plasmatic Polyunsaturated Fatty Acids Concentrations and Cognitive Status and Decline in Neurocognitive Disorders.

OBJECTIVE: To examine the association of plasmatic and erythrocyte concentrations polyunsaturated fatty acids (PUFA) with both cognitive status and decline. DESIGN: Longitudinal observational cohort study. SETTING: Memory Clinic of Lyon Sud university hospital. PARTICIPANTS: 140 patients, aged 60 and older, were referred to the memory clinic, and successively included in the cohort, between March 2010 and February 2014. MEASUREMENTS: Concentration of ω-3 PUFA (eicosapentaenoic: EPA and docosahexaenoic: DHA) and ω-6 PUFA (arachidonic: AA), were measured at baseline in plasma and in the erythrocytes membrane. Cognitive status was assessed using the mini mental state examination (MMSE), at baseline and every six months during follow-up. The median follow-up period was of 11,5 months. RESULTS: Compared to participants with minor neurocognitive disorders (MMSE≥24), participants with major neurocognitive disorders (NCD) had lower plasmatic concentrations of EPA and DHA (p<0.05) at baseline. Erythrocyte AA and DHA concentrations were significantly lower in patients with cognitive decline (defined as a ≥2 points loss of MMSE per year), while no difference in plasmatic concentrations was observed. CONCLUSIONS: Our study suggests that ω-3 PUFA plasma concentrations (mainly EPA and DHA) could be associated with cognitive status in older people. Moreover, in this exploratory study, lower erythrocyte PUFA concentrations (AA and DHA) were associated with accelerated decline and could be proposed as a surrogate marker for prediction of cognitive decline.

Children and adolescents with cystic fibrosis display moderate bone microarchitecture abnormalities: data from high-resolution peripheral quantitative computed tomography.

We investigated whether bone microstructure assessed by high-resolution peripheral quantitative tomography (HR-pQCT) could be altered in children and teenagers with cystic fibrosis (CF). In comparison to their healthy counterparts, bone microstructure was mildly affected at the tibial level only. INTRODUCTION: Cystic fibrosis-related bone disease (CFBD) may alter bone health, ultimately predisposing patients to bone fractures. Our aim was to assess bone microstructure using high-resolution peripheral quantitative tomography (HR-pQCT) in a cohort of children and teenagers with CF in comparison to age-, puberty-, and gender-matched healthy volunteers (HVs). METHODS: In this single-center, prospective, cross-sectional study, we evaluated the HR-pQCT bone parameters of CF patients and compared them to those of the healthy volunteers. RESULTS: At a median age of 15.4 [range, 10.5-17.9] years, 37 CF patients (21 boys) with 91% [range, 46-138%] median forced expiratory volume in 1 s were included. At the ultradistal tibia, CF patients had a smaller bone cross-sectional area (579 [range, 399-1087] mm2) than HVs (655 [range, 445-981] mm2) (p = 0.027), related to a decreased trabecular area, without any significant differences for height. No other differences were found (trabecular number, separation, thickness, or distribution) at the radial or tibial levels. Bone structure was different in patients receiving ursodeoxycholic acid and those bearing two F508del mutations. CONCLUSION: In our cohort of children and teenagers with good nutritional and lung function status, bone microstructure evaluated with HR-pQCT was not severely affected. Minimal microstructure abnormalities observed at the tibial level may be related to the cystic fibrosis transmembrane conductance regulator defect alone; the long-term consequences of such impairment will require further evaluation.

Plasma acyl-ghrelin increases after meal initiation: a new insight.

BACKGROUND/OBJECTIVES: Plasma ghrelin secretion over time in humans is characterized by pre-prandial increases and by post-prandial decreases all day long. However, some authors who measured ghrelin concentrations around meals showed a rise in plasma ghrelin concentration after meal initiation followed by the typical post-prandial decrease. In order to confirm this observation that has never been discussed, we described ghrelin profiles around four eating episodes in the morning in adult men. SUBJECTS/METHODS: Twenty normal-weight and 17 obese men were instructed to eat four fixed meals (706 kJ) 10 min long at 0800 h, 0900 h, 1000 h and 1100 h. Using frequent blood sampling, we determined plasma acyl-ghrelin concentrations around those eating episodes. Glucose, insulin and GLP-1 concentrations were also measured. RESULTS: The meals consumption induced a significant increase in plasma acyl-ghrelin concentrations 10 min after meal initiation (P<0.0001): +20.9±5.8 and +10.7±3.3 pg/ml in normal-weight and obese subjects for the first meal; +10.4±3.0 and +5.5±3.9 pg/ml in normal-weight and obese subjects for the second meal; +12.4±3.6 and +4.2±2.1 pg/ml in normal-weight and obese subjects for the third meal; and +4.4±4.1 and +3.3±2.61 pg/ml in normal-weight and obese subjects for the fourth meal. CONCLUSIONS: This study is the first to describe and discuss the post-meal initiation ghrelin increase. This finding is consistent in normal-weight and obese individuals.

Salivary composition in obese vs normal-weight subjects: towards a role in postprandial lipid metabolism?

In the pathophysiological context of obesity, oral exposure to dietary fat can modulate lipid digestion and absorption, but underlying in-mouth mechanisms have not been clearly identified. Therefore, we tested the hypothesis that salivary components related to dietary fat sensitivity would differ according to body mass index (BMI) and postprandial lipid metabolism in young men. Saliva was collected from nine normal-weight (BMI=22.3±0.5 kg m(-2)) and nine non-morbid obese (BMI=31.7±0.3 kg m(-2)) men before an 8-h postprandial metabolic exploration test involving the consumption of a 40-g fat meal, in which obese subjects revealed a delayed postprandial lipid metabolism. Nine salivary characteristics (flow, protein content, lipolysis, amylase, proteolysis, total antioxidant status, lysozyme, lipocalin 1 and carbonic anhydrase-VI) were investigated. We show that, under fasting conditions, salivary lipolysis was lower in obese vs normal-weight subjects, whereas proteolysis and carbonic anhydrase VI were higher. We reveal through multivariate and Mann-Whitney analysis that differences in fasting salivary lipolysis and proteolysis between both groups are related to differences in postprandial lipid metabolism including exogenous fatty-acid absorption and ß-oxidation. These results suggest a potential role of salivary composition on postprandial lipid metabolism and bring novel causal hypotheses on the links between salivary composition, sensitivity to dietary fat oral income and postprandial lipid metabolism according to BMI.

Are third-trimester adipokines associated with higher metabolic risk among women with gestational diabetes?

AIM: This study aimed to determine whether third-trimester adipokines during gestational diabetes (GDM) are associated with higher metabolic risk. METHODS: A total of 221 women with GDM (according to IADPSG criteria) were enrolled between 2011/11 and 2013/6 into a prospective observational study (IMAGE), and categorized as having elevated fasting blood glucose (FBG) or impaired fasting glucose (IFG, n = 36) if levels were ≥ 92 mg/dL during a 75-g oral glucose tolerance test (OGTT), impaired glucose tolerance (IGT, n = 116) if FBG was < 92 mg/dL but with elevated 1-h or 2-h OGTT values, or impaired fasting and stimulated blood glucose (IFSG, n = 69) if both FBG was ≥ 92 mg/dL and 1-h or 2-h OGTT values were elevated. RESULTS: Pre-gestational body mass index (BMI) was higher in women with IFG or IFSG compared with IGT (P < 0.001), as were leptin levels in women with IFG vs IGT [34.7 (10.5-119.7) vs 26.6 (3.56-79.4) ng/L; P = 0.008]. HOMA2-IR scores were higher in women with IFG or IFSG vs IGT (1.87 ± 1.2 or 1.72 ± 0.9 vs 1.18 ± 0.8, respectively; P < 0.001). Also, those with IFSG vs those with IGT had significantly lower HOMA2-B scores (111.4 ± 41.3 vs 127.1 ± 61.6, respectively; P < 0.05) and adiponectin levels [5.00 (1.11-11.3) vs 6.19 (2.11-17.7) µg/mL; P < 0.001], and higher levels of IL-6 [1.14 (0.33-20.0) vs 0.90 (0.31-19.0); P = 0.012] and TNF-α [0.99 (0.50-10.5) vs 0.84 (0.45-11.5) pg/mL; P = 0.003]. After adjusting for age, parity, and pre-gestational and gestational BMI, the difference in adiponectin levels remained significant. CONCLUSION: Diagnosing GDM by IADSPG criteria results in a wide range of heterogeneity. Our study has indicated that adipokine levels in addition to FBG may help to select women at high metabolic risk for appropriate monitoring and post-delivery interventions (ClinicalTrials.gov number NCP02133729).

[Aseptic process validation and stability study of an injectable preparation of fructose (5%)-glycerol (10%) as part of a hospital clinical research program on endoscopic curative treatment for early epithelial neoplastic lesions of the gastrointestinal tract]. / Validation du procédé aseptique et étude de stabilité d'une préparation injectable de fructose (5 %)-glycérol (10 %) dans le cadre d'un programme hospitalier de recherche clinique portant sur le traitement curatif endoscopique des lésions néoplasiques épithéliales précoces du tube digestif.

INTRODUCTION: As part of a hospital clinical research program on endoscopic curative treatment for early epithelial neoplastic lesions of the gastrointestinal tract, a new hospital sterile and non-pyrogenic preparation of fructose (5%)-glycerol (10%) was realized. Under pharmaceutical legislation, the provision of this hospital preparation involves of aseptic process validation and achieve a stability study. MATERIALS AND METHODS: After the aseptic process validation with Mediafill Test, the preparation was made under aseptic conditions associated with a sterilizing filtration according to the good practices preparation. Prepared flexible bags (100mL of solution) were stored for one year in a climatic chamber (25±2°C). To assess stability, the physicochemical controls (fructose concentration, glycerol concentration, hydroxy-methyl-5 furfural [5-HMF] concentration, sodium concentration, pH measure, osmolality and sub-visible particles count) and microbiological (bioburden, bacterial endotoxin and sterility) were performed at regular intervals for one year. RESULTS: Neither significant decrease of fructose concentration, glycerol concentration and sodium concentration nor pH, 5-HMF, osmolality variations out of specifications were observed for one year. The sub-visible particles count, the bacterial endotoxin and sterility were in accordance with the European pharmacopoeia attesting limpidity, apyrogenicity and sterility of this injectable preparation. DISCUSSION AND CONCLUSION: The hospital preparation was stable over one year at 25±2°C, ensuring safe administration in humans within the framework of this clinical research.

Increased TSH in obesity: Evidence for a BMI-independent association with leptin.

AIM: This study aimed to determine whether the association between thyroid-stimulating hormone (TSH) and body mass index (BMI) is related to leptin concentration in obese individuals. METHODS: Plasma TSH and leptin assays were performed in 800 consecutive patients, hospitalized for a nutritional checkup, with a BMI ≥ 30 kg/m(2). Various anthropometric, hormonal and metabolic parameters, including age, weight, BMI, insulin, leptin and TSH, were measured or calculated. Univariate and multivariate regression analyses were performed to identify any significant relationships between these parameters. Also, characteristics of the patients in the lowest and highest quartiles of TSH distribution were compared. RESULTS: TSH was positively correlated with both BMI and leptin. When multiple regression analysis was performed, TSH and leptin maintained a significant association independent of BMI. Patients in the fourth quartile of TSH distribution displayed higher BMI and higher leptin levels in comparison to the first quartile. CONCLUSION: Our study has confirmed an increase in TSH in conjunction with BMI in obese subjects. This increase was correlated with leptin independently of BMI. It is hypothesized that the increase in TSH observed in obese subjects was the consequence of both fat mass accumulation and a positive energy-balance.

[Should we propose a systematic second transurethral resection of the bladder for all high-risk non-muscle invasive bladder cancers?]. / Faut-il proposer une seconde résection systématique pour toutes les tumeurs de vessie n'infiltrant pas le muscle vésical à risque élevé ?

OBJECTIVE: Quantify the rate of residual bladder tumor following systematic second look resection of pTa high-grade versus pT1 high-grade patients. MATERIAL AND METHODS: From January 2010 to July 2013, 53 patients with a non-muscle-invasive bladder cancer with high-risk of recurrence and progression underwent a second systematic resection in accordance with the current guidelines of the French Association of Urology (AFU). RESULTS: Among the 53 patients with a high-risk non-muscle-invasive bladder cancer, histological examination of the initial resection identified: 17 pTa high-grade (32.1%) and 36 pT1 high-grade (67.9%). There was a significant difference between the 2 groups of patients (Ta high-grade versus T1 high-grade) concerning the rate of residual tumor on second look resection (11.8% versus 66.7%, P=0.0002). The predictive factors of residual tumor after second resection were the pT1 stage (P=0.0002), tumor multifocality (P=0.02) and presence of associated Cis (P=0.0005). CONCLUSION: The high rate of residual tumor in our series confirmed the importance of a systematic second look resection for high-risk non-muscle-invasive bladder cancers. However, for the pTa tumors without associated Cis, the interest of this second look seemed of less concern. LEVEL OF EVIDENCE: 5.

Surgical management of locally advanced and metastatic renal cancer: neoadjuvant and adjuvant strategies.

Surgery remains the treatment of choice for locally advanced or metastatic renal cell carcinoma. However, the contribution of targeted therapies has recently significantly impacted recurrence-free survival in metastatic patients, challenging in some cases the real interest of nephrectomy. Waiting for the results of CARMENA trial, assessing the impact of cytoreductive nephrectomy on survival, neoadjuvant and adjuvant strategies are emerging. In locally advanced disease, adjuvant therapy should be considered if the patient is considered at high risk of progression, and therefore require its inclusion in a prospective randomized trial. Neo-adjuvant anti-angiogenic strategies show a quite modest improvement in resectability of primary tumor, while allowing performing translational research. However, many questions remain on hold in terms of precise indications, choice of drugs, toxicity and optimal dosing schedule. All these questions explain the current development of phase III trials.

The two-year outcome of the I-Stop TOMS™ transobturator sling in the treatment of male stress urinary incontinence in a single centre and prediction of outcome.

PURPOSE: The aim of this study was to present the results of the 2 year outcome of I-Stop TOMS™ transobturator sling for post-prostatectomy (UIPP) minor to moderate male urinary incontinence treatment. MATERIALS AND METHODS: A prospective, single center study, including 26 patients with minor to moderate IUPP and operated on using a suburethral sling (MS) TOMS™ (four arms) was performed. UIPP assessment was made preoperatively and 1 year postoperatively, using validated questionnaires (SF36 and ICIQ), number of pads daily, and the 24 hours Pad-test (LPT). Telephone follow-up evaluation was performed in 21 patients over a 2 years period following surgery. RESULTS: Radical prostatectomy was performed 48.4 months earlier and average patient age was 67.3 years. Preoperatively, the mean number of pads used daily was 2.3 with an average weight loss of 207.1grams at LPT. At 1 year, ICIQ and SF36 scores significantly improved. Weight loss in the LPT as well as the number of pads significantly decreased (P<0.05). At 1 year, 13 patients were cured, 12 were improved, one reached improvement criteria, and 96.2% using a pad daily maximum. With more than a 2 year follow-up, 10/21 patients were dry, nine improved and two failed, and 90.5% using 0 to 1 pad per day. CONCLUSIONS: The transobturator TOMS™ male sling is a simple and well-tolerated procedure permitting a significant improvement of UIPP, with 50% of patients achieving complete continence at 1 year postoperatively, these good results continued beyond 2 years. LEVEL OF EVIDENCE: 4.

[New anti-angiogenic strategies in the management of kidney cancer]. / Nouvelles stratégies anti-angiogéniques dans la prise en charge du cancer du rein.

INTRODUCTION: The aim of this study was to clarify the current role of adjuvant and neo-adjuvant in the treatment of kidney cancer. MATERIALS AND METHODS: The data were explored in Medline (http://www.ncbi.nlm.nih.gov) using the following MeSH terms or combinations of these keywords: "cancer", "rein", "kidney", "adjuvant", "neoadjuvant", "antiangiogenique", "antiangiogenic" and selecting the items produced in their methodology, their relevance to the theme explored and their date of publication. RESULTS: Thirty-two English and French items published between 2001 and 2011 were selected: five studies of evidence level 1, nine level 2 studies, nine level 4 studies, five studies at level 5 and four literature reviews. The cytoreductive nephrectomy as first-line treatment of locally advanced or metastatic kidney cancer is now controversial with the advent of new targeted anti-angiogenic therapies. In neoadjuvant setting, these treatments showed a moderate decrease in tumor volume and rarely improved resectability. In adjuvant setting, their place has yet to be specified and several trials are currently underway. CONCLUSION: Recent years have seen the anti-angiogenic therapeutic strategies upset in locally advanced and metastatic renal cancer. The development of clinical trials and research protocols will allow us to determine in the near future the optimal therapeutic sequences.

[Management of acute pyelonephritis]. / Prise en charge des pyélonéphrites aiguës.

Pyelonephritis is a bacterial infection of the upper urinary tract and renal parenchyma. Infection occurs primarily by urinary contamination upward and backward from the intestinal flora, and genital skin, explaining that the seeds are most commonly encountered Gram-Negative bacilli (GNB), Escherichia coli in mind. The peak incidence is among women aged 15 to 65, but pyelonephritis may include subjects of all ages and both sexes. The diagnosis is usually straightforward and based on a combination of fever, unilateral flank pain and a positive urine culture. Biology and imaging aim to seek any form of pyelonephritis complicated, especially due to the obstructive form a barrier (usually a calculation) of the urinary tract and is a surgical emergency. Support depends on the existence of signs of severity or complications. Treatment consists of antibiotics, to begin immediately, initially probabilistic and secondarily adapted to the antibiogram. Patients hospitalized in the urology will be those with complicated pyelonephritis (urinary obstruction, abscess, sepsis, renal insufficiency, solitary kidney, comorbidity).

[Limit of short Pad-Test and questionnaires about urinary incontinence evaluation after prostatectomy]. / Limite du Pad-Test Court et des questionnaires dans l'évaluation de l'incontinence urinaire post-prostatectomie.

PURPOSE: Clinical study among men suffering from postprostatectomy urinary incontinence comparing the short term Pad-Test to urinary symptom questionnaires. PATIENTS AND METHODS: From June 2006 to November 2008, 16 patients presenting a urinary incontinence after prostatectomy have been operated by I-Stop® TOMS male sling. The incontinence has been evaluated by analyzing data from the short Pad-Test, ICIQ and SF36 questionnaires. This evaluation has been done before surgery (Day 0) and 90 days after (Day 90). The short term Pad-Test was recommended by the International Continence Society. The analysis between the values has been appreciated by Kendall ratio with a significant value, for the independence test, if smaller than 0.05. RESULT: We can't demonstrate any significant evolutive correlation of the short term Pad-Test and ICIQ or SF36 questionnaires results between Day 0 and Day 90. At Day 0, there is no significant link between short-term Pad-Test and ICIQ or SF36 questionnaires results. CONCLUSION: The absence of correlation between the two evaluations before surgery confirms the interest of a double evaluation, objective and subjective. The short-term Pad-Test is easy to perform but presents a limited variability of the measure and a lack of precision in leakage detection. Nevertheless, there is a bias of selection in the recruited population who suffered from a minor or moderated urinary incontinence after prostatectomy, according to Stamey standards. The authors propose to prefer 24 hours Pad-Test which evaluate the leakage on a larger period of time.

Plasma adiponectin concentration has an inverse and a non linear association with estimated glomerular filtration rate in patients with K/DOQI 3 - 5 chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) is associated with an increased incidence of cardiovascular disease (CVD). A few studies have demonstrated elevated plasma adiponectin and leptin levels in CKD. The aims of this study were to assess whether 1) estimated glomerular filtration rate (eGFR) is associated with plasma leptin and adiponectin; and 2) adiponectin and leptin (partly) explain associations of CKD with endothelial dysfunction, insulin resistance, and low-grade inflammation in patients with K/DOQI Stage 3 - 5 CKD. METHODS: Baseline data from 91 patients with Stage 3 - 4 CKD in the anti-oxidant therapy in chronic renal insufficiency study, a randomized, double-blind, placebo-controlled trial, in which the effects of oxidative stress-lowering treatment on vascular function and structure were studied, and from 50 dialysis naïve patients, who took part in an open-label, randomized study that compared two peritoneal dialysis regimens, used in the analysis. All subjects for both the studies were recruited in the same centres. RESULTS: The association between eGFR and adiponectin was non-linear. In multivariate analysis, log-eGFR (unstandardized beta = 8.303 microg/ml, p < 0.0001) was the strongest determinant of adiponectin, and body mass index the strongest determinant of leptin (beta = 2.477 ng/ml, p < 0.0001). Plasma adiponectin and leptin did not modify the associations between eGFR and plasma von Willebrand factor or soluble vascular adhesion molecule-1. Plasma leptin had the strongest association with the homeostatic model assessment (HOMA-IR) index. Plasma C-reactive protein had no association with adiponectin or leptin. CONCLUSIONS: In patients with K/DOQI Stage 3 - 5 CKD, renal function had a significant non-linear inverse association with and was the strongest predictor of adiponectin. BMI was the strongest predictor of plasma leptin. Plasma adiponectin and leptin did not explain, and thus presumably are not involved in, the association between eGFR and some markers of endothelial dysfunction.

Fasting plasma carotenoids concentrations in Crohn's and pancreatic cancer patients compared to control subjects.

Carotenoids are colored molecules that are widespread in the plant kingdom, but animals cannot synthesize them. Carotenes are long, apolar molecules which require fully functioning digestive processes to be absorbed properly. Hence they could be interesting markers of intestinal absorption and digestion. Indeed, only few tests are available to assess these processes and only the D-xylose tolerance test is routinely used. However D-xylose is a sugar that tests only the absorption of water-soluble compounds and it only tests duodenal absorption. In this study, we have evaluated carotenoids as markers of digestion and absorption. We compared fasting plasma carotenoids concentrations in 21 control subjects, 20 patients with Crohn's disease, and 18 patients with pancreatic cancer. Crohn's disease alters intestinal absorption while pancreatic cancer decreases pancreatic enzyme secretion thus impairing digestion. Results show that all carotenoids are significantly lower in Crohn's and cancer patients as compared to control subjects and the multifactorial analysis shows that this decrease is mostly independent of dietary intake. Interestingly, maldigestion as seen in pancreatic cancer more strongly influences plasma lutein and lycopene concentrations while malabsorption in Crohn's disease acts on other carotenoids. Thus carotenoids could be interesting alternatives for testing and following patients that are suspected of having malabsorption or maldigestion syndromes.

[Biomarkers of lipid peroxidation: analytical aspects]. / Biomarqueurs de la peroxydation lipidique: aspects analytiques.

During these last years, oxidative stress has been implicated in various pathological situations. The difficulty is to choose a convenient marker to appreciate its importance in vivo because of analytical problems of specificity and sensitivity. The oxidized lipids, formed during lipid peroxidation, illustrate these problems. Among these markers are 'primary' products such as hydroperoxides, or 'secondary' products such as malondialdéhyde (MDA), 4-hydroxynonénal (4-HNE) and isoprostanes. They are all measurable in biological fluids and analytical methods used are sometimes complex and require sample preparation involving extraction and purification steps. F2-isoprostanes are certainly the most specific markers of lipid peroxidation but also the most difficult to measure. Many assays have been recently developed. Some, such as gas or liquid chromatography coupled with mass spectrometry are the 'gold standard' methods, they allow to measure different F2-isoprostanes but require special apparatus. Others, like immunoassay methods measure one isoprostane, they are simpler to perform and accessible to a greater number of laboratories but still lack of specificity.

Plasma fatty acids and lipid hydroperoxides increase after antibiotic therapy in cystic fibrosis.

The present authors investigated whether cystic fibrosis is linked to a defect in fatty acids and assessed the impact of the main patients' characteristics on the levels of several fatty acids, mostly during respiratory exacerbation and after antibiotic therapy. Fatty acid phospholipid and cholesteryl ester levels were measured in stable-state patients and controls. No differences were found concerning either the fractions of palmitic and oleic acids or the cholesteryl esters of alpha-linolenic and arachidonic acids. However, phospholipids of alpha-linolenic and arachidonic acids, as well as cholesteryl esters and phospholipids of stearic and linoleic acids, were lower in patients than in controls, but fractions of dihomo-gamma-linolenic, docosatetraenoic, docosapentaenoic, palmitoleic and eicosatrienoic acids were higher. Fatty acid levels, oxidative stress markers, nutrients, body mass index and forced expiratory volume in one second (FEV(1)) were measured in patients before and after antibiotic courses for bronchial exacerbation. After adjustments, palmitic, stearic, alpha-linolenic, linoleic, arachidonic, palmitoleic and oleic acids generally decreased during exacerbation but almost all increased after antibiotic courses. Nearly all fractions increased along with FEV(1) and a positive relationship linked fatty acids to lipid hydroperoxides. There was no general drop in fatty acids. Patients' fatty acid profiles depended on the pulmonary function and the inflammation state.

[Recent knowledge about intestinal absorption and cleavage of carotenoids]. / Données récentes sur l'absorption et le catabolisme des caroténoïdes.

Our knowledge about intestinal absorption and cleavage of carotenoids has rapidly grown during the last years. New facts about carotenoid absorption have emerged while some controversies about cleavage are close to end. The knowledge of the absorption and conversion processes is indispensable to understand and interpret the perturbations that can occur in the metabolism of carotenoids and vitamin A. Recently, it has been shown that the absorption of certain carotenoids is not passive - as believed for a long time - but is a facilitated process that requires, at least for lutein, the class B-type 1 scavenger receptor (SR-B1). Various epidemiological and clinical studies have shown wide variations in carotenoid absorption from one subject to another, such differences are now explained by the structure of the concerned carotenoid, by the nature of the food that is absorbed with the carotenoid, by diverse exogenous factors like the intake of medicines or interfering components, by diet factors, by genetic factors, and by the nutritional status of the subject. Recently, the precise mechanism of beta-carotene cleavage by betabeta-carotene 15,15' monooxygenase (EC 1.14.99.36) - formerly called beta-carotene 15,15' dioxygenase (ex EC 1.13.11.21) - has been discovered, and a second enzyme which cleaves asymmetrically the beta-carotene molecule has been found. beta-carotene 15,15' monooxygenase only acts on the 15,15' bond, thus forming two molecules of retinal from one molecule of beta-carotene by central cleavage. Even though the betabeta-carotene 15,15' monooxygenase is much more active on the beta-carotene molecule, a study has shown that it can act on all carotenoids. Searchers now agree that other enzymes that can catalyse an eccentric cleavage of carotenoids probably exist, but under physiological conditions the betabeta-carotene 15,15' monooxygenase is by far the most active, and it is mainly effective in the small bowel mucosa and in the liver. However the conversion of provitamin A carotenoids into vitamin A is only partial, and requires a satisfactory protein status.

[Should blood samples be drawn on heparin-anticoagulant for lipid analysis?]. / Peut-on prélever le bilan lipidique sur héparine?

Lipid profile is often performed on heparinized-plasma because nothing in particular is explained in the technical data sheet about anticoagulant and because few data (mainly with EDTA anticoagulant) are available in literature. In order to evaluate heparinized-plasma vs serum differences, 50 normo- or hyperlipidemic samples were collected and assayed in 3 clinical laboratories in Lyon on Hitachi analysers with Roche Diagnostic reagents. Lipid values are lower in plasma than in serum; the average negative bias for cholesterol levels is 2 to 4,5% and for triglycerides about 3%, depending on the laboratory; the effect on HDL-cholesterol values is not significant. These results were confirmed by manual procedure on 28 samples with Roche Diagnostic reagent and two similar other reagents (Biomerieux and Randox). A negative bias of 4% on total cholesterol and triglycerides levels is not very important for clinical diagnosis but it is more serious for LDL-cholesterol estimated with Friedewald equation; LDL-cholesterol value needs accuracy because it is a therapeutic goal with statin therapy and an high negative bias (until 0,70 g/L in our results) is unacceptable; moreover, there is a real risk of providing false total cholesterol results. Therefore it is essential to collect blood for lipid profile without any anticoagulant.

[Hypocholesterolemia in hospitalized elderly: relations with inflammatory and nutritional status]. / Hypocholestérolémie du sujet âgé: influence de l'inflammation et de la dénutrition.

PURPOSE: Hypocholesterolemia is a common finding in hospitalized elderly people and is associated with increased mortality. Changes in plasma lipid levels are well known in the acute phase response. It has also been suggested that malnutrition is a cause of hypocholesterolemia. However, malnutrition is the reflect of general condition, and the respective roles of malnutrition and inflammation have not yet been clearly established. This research project was undertaken to examine the impact of nutritional and inflammatory status on the hypocholesterolemia. METHODS: In a prospective study, 597 elderly patients (83 +/- 7 years) consecutively admitted in a geriatric acute care unit were included. Clinical and anthropometric data: Body Mass Index (BMI), Tricipital Skinfold Thickness (TSF), Sub-Scapular Skinfold Thickness (SSF), Mid Arm Circumference (MAC) have been collected. The blood samples were obtained within the 72 hours following the admission. Nutritional proteins (albumin, prealbumin, transferrin, retinol binding protein); inflammatory proteins (CRP, alpha-1 acid glycoprotein), and blood lipids (cholesterol, LDL, HDL cholesterol, triglycerides, apoproteins A1 and B) were dosed. RESULTS: The anthropometric and biologic parameters have been compared on the two sexes, significant differences were observed only for blood lipids. The analyses are thus realized and presented by sex separately. Four groups of patients are generated according to the quartile of total cholesterol. Means and standard deviation for all factors are calculated within each group. Both, the trend of means and analyses of correlation show associations with cholesterol in the two sexes. The analysis of variance showed that the cholesterolemia is associated with 1/ decrease in the values of the anthropometrics, and nutritional proteins and 2/ upward trends of the inflammatory parameters. Significant correlations were observed for all transport proteins and CRP with total cholesterol in men and women. The multiple linear regression of the total cholesterol retained albumin, APO A1, APO B and RBP as predictor factors of cholesterolemia for women and APO A1, APO B and tryglicerid for men. When patients with infectious diseases were compared to the others, significant differences have been observed for total cholesterol and all blood lipids, as well as for nutritional and inflammatory proteins. CONCLUSION: The results confirm an association between nutritional status and hypocholesterolemia, and suggest also the responsability of inflammation as a cause of hypocholesterolemia.